Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group

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Item Type:	Article
Title:	Improved outcome in childhood acute lymphoblastic leukemia despite reduced use of anthracyclines and cranial radiotherapy: results of trial ALL-BFM 90. German-Austrian-Swiss ALL-BFM Study Group
Creators Name:	Schrappe, M., Reiter, A., Ludwig, W.D., Harbott, J., Zimmermann, M., Hiddemann, W., Niemeyer, C., Henze, G., Feldges, A., Zintl, F., Kornhuber, B., Ritter, J., Welte, K., Gadner, H. and Riehm, H.
Abstract:	Trial ALL-BFM 90 was designed to improve outcome in patients with childhood acute lymphoblastic leukemia (ALL) by using a reduced treatment regimen. Patients were stratified into a standard-risk group (SRG), a medium-risk group (MRG), both defined by adequate early treatment response; and a high-risk group (HRG), defined by inadequate response to the cytoreductive prednisone prephase, induction failure, or Philadelphia-chromosome-positive ALL. Four treatment modifications were evaluated: dose intensification in induction by a more rapid drug sequence; administration of L-asparaginase during consolidation therapy in the MRG (randomized); enforced consolidation by rotational elements in the HRG; and reduction in the dose of anthracyclines and use of only 12-Gy preventive cranial radiotherapy in the MRG and HRG, with the aim of avoiding toxicity. Among all 2178 patients (</= 18 years of age), the 6-year event-free survival (EFS) rate (+/- SE) was 78% +/- 1%, with a median observation time of 4.8 years. EFS was 85% +/- 2% in the SRG (n = 636) and 82% +/- 1% in the MRG (n = 1299). L-asparaginase did not improve outcome in the MRG: the event-free interval was 83% +/- 2% with L-asparaginase (n = 528) and 81% +/- 2% without it (n = 557). Because there were more systemic relapses in the HRG (n = 243), EFS was 34% +/- 3%, an outcome inferior to that in the HRG in a previous trial, ALL-BFM 86, in which EFS was 47% +/- 5% (P =.04). The rates of isolated central nervous system relapse in the MRG and HRG were 0.8% and 1.6%, respectively; thus, the 12-Gy preventive cranial radiotherapy regimen apparently provided sufficient central nervous system prophylaxis. The overall improvement over the results in ALL-BFM 86 (6-year EFS, 72%; P =. 001) was based on fewer recurrences among patients in the MRG with B-cell-precursor ALL, indicating an advantage of more condensed induction therapy. In multivariate analysis, inadequate in vivo response emerged as the strongest adverse prognostic variable.
Keywords:	Antineoplastic Antibiotics, Antineoplastic Combined Chemotherapy Protocols, Asparaginase, Brain Neoplasms, Cranial Irradiation, Disease-Free Survival, Immunophenotyping, Myelogenous, Chronic, BCR-ABL Positive Leukemia, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Prognosis, Regression Analysis, Survival Analysis, Time Factors, Treatment Outcome
Source:	Blood
ISSN:	0006-4971
Publisher:	American Society of Hematology
Volume:	95
Number:	11
Page Range:	3310-3322
Date:	1 June 2000
Official Publication:	http://bloodjournal.hematologylibrary.org/cgi/content/abstract/95/11/3310
PubMed:	View item in PubMed

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